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Current status of esophageal cancer – West versus East: the European point of view

机译：食管癌的现状–西方与东方：欧洲的观点

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Esophageal cancer and its treatment differ largely between the West and the East because West and East are concerned – at least in part – with different diseases: squamous cell cancers are the prevailing tumor type in Japan and other parts of Asia whereas this entity is now clearly outnumbered in Europe and North America by esophageal adenocarcinoma. The latter are mostly Barretts cancers, arising within the precancerous Barretts esophagus, promoted by the chronically damaging effect of gastro-esophageal reflux. The epidemiological differences entail differences in treatment concepts: esophageal cancer in principle is a surgical disease in Japan, with a high prevalence of early tumor stages in everyday clinical practice. In the West, a majority of esophageal cancers are seen in an advanced stage. Many tumors, in which R0 resection by primary surgery is unlikely, are approached with neo-adjuvant protocols that aim at downsizing of the tumor/downstaging of the disease before subsequent surgical resection. In Japan, by contrast, multimodal therapy is preferentially used in the adjuvant setting, in patients regarded at risk for recurrence. There have also been several very similar developments in the West and the East, especially the improved prognosis after esophageal cancer resection. Better long-term results (prolonged survival) are closely related to improved short-term results (decrease of morbidity and mortality) after esophagectomy. Both effects are multifactorial in nature and are attributable to better patient selection (risk analysis, improved staging), standardization of surgical techniques, and concentration of treatment in specialized high-volume centers.
机译：食管癌及其治疗方法在西方和东方之间存在很大差异，因为西方和东方（至少部分地）关注不同的疾病：鳞状细胞癌是日本和亚洲其他地区的主要肿瘤类型，而这一实体现在很明显在欧洲和北美，食管腺癌的数量超过了欧洲。后者主要是Barretts癌，发生在癌前Barretts食道内，由胃食管反流的慢性破坏作用促进。流行病学差异导致治疗概念的差异：原则上，食管癌在日本是一种外科疾病，在日常临床实践中早期肿瘤阶段的患病率很高。在西方，大多数食道癌都处于晚期。新辅助方案旨在治疗许多不可能通过原发手术切除R0的肿瘤，这些方案旨在缩小肿瘤尺寸/降低疾病分期，然后再进行手术切除。相反，在日本，对于被认为有复发风险的患者，多模式疗法优先用于辅助治疗。西方和东方也有一些非常相似的发展，尤其是食管癌切除后预后的改善。更好的长期结果（延长的生存期）与食管切除术后短期结果的改善（发病率和死亡率的降低）密切相关。这两种效果本质上都是多因素的，可归因于更好的患者选择（风险分析，改进的分期），手术技术的标准化以及专业化大容量中心的治疗集中。

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